Dental Amalgam

Considerations: 

1. Although dental amalgam is the single largest source of mercury exposure for average Americans, current evidence does not indicate that dental amalgam is causing illness in the general population. However, there is a small percentage of the population which is hypersensitive to mercury and can suffer severe health effects from even a low exposure. 

2. A total ban on amalgam is not considered justified. Neither is the removal of sound amalgam fillings in patients who have no indication of adverse health effects attributable to mercury exposure. 

3. As a general principle, it is advisable to reduce human exposure to heavy metals in our environment, even if there is no clinical evidence of adverse health effects, provided the reduction can be achieved at reasonable cost and without introducing other adverse effects. 

Recommendations: 

1. Non-mercury filling materials should be considered for restoring the primary teeth of children where the mechanical properties of the material are suitable. 

2. Whenever possible, amalgam fillings should not be placed in or removed from the teeth of pregnant women. 

3. Amalgam should not be placed in patients with impaired kidney function. 

4. In placing and removing amalgam fillings, dentists should use techniques and equipment to minimize the exposure of the patient and the dentist to mercury vapor, and to prevent amalgam waste from being flushed into municipal sewage systems. 

5. Dentists should advise individuals who may have allergic hypersensitivity to mercury to avoid the use of amalgam. In patients who have developed hypersensitivity to amalgam, existing amalgam restorations should be replaced with another material where this is recommended by a physician. 

6. New amalgam fillings should not be placed in contact with existing metal devices in the mouth such as braces. 

7. Dentists should provide their patients with sufficient information to make an informed choice regarding the material used to fill their teeth, including information on the risks and benefits of the material and suitable alternatives. 

8. Dentists should acknowledge the patient’s right to decline treatment with any dental material.

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